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Current strategies for ischemic stroke prevention: role of multimodal combination therapies

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Abstract

Stroke remains a global leading cause of death and long-term disability, highlighting the need for more effective treatment approaches. The majority of strokes are of ischemic origin, often caused by large- or small-artery atherothrombosis, or cardioembolism. Considering the systemic nature of the atherothrombotic disease process, stroke patients are at increased risk for ischemic events in several vascular territories: cerebral, coronary and peripheral. Due to the limited options for acute stroke therapies, stroke prevention is an important therapeutic approach. In addition to the management of modifiable risk factors such as hypertension, dyslipidemia and smoking through pharmacotherapy or lifestyle adjustments, anticoagulants, surgical and perhaps endovascular approaches are indicated in certain patients. Antiplatelet therapies using various agents are a cornerstone of secondary stroke prevention. To ensure the appropriate continuum of care after hospitalization for ischemic stroke, some interventions for the prevention of recurrent ischemic stroke should be initiated during the acute hospitalization setting and maintained in the out-patient setting.

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References

  1. (2005) ASCOT blood pressure-lowering arm -study of effects of two BPlowering regimens in hypertensive patients with cardiovascular risk factors. Cardiovasc J S Afr 16(124):126-27

  2. (2002) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324:71-6

  3. (1989) Final report on the aspirin component of the ongoing Physicians' Health Study. Steering Committee of the Physicians' Health Study Research Group. N Engl J Med 321:129-35

  4. The Internet Stroke Center. Stroke Trials Directory. In: http://www. strokecenter. org/trials

  5. (2002) MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20, 536 high-risk individuals: a randomised placebo-controlled trial. Lancet 360:7-2

  6. (2001) Randomised trial of a perindopril- based blood-pressure-lowering regimen among 6, 105 individuals with previous stroke or transient ischaemic attack. Lancet 358:1033-041

  7. (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 348:1329-339

  8. (1994) Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med 154:1449-457

  9. (2004) Statins after ischemic stroke and transient ischemic attack: an advisory statement from the Stroke Council, American Heart Association and American Stroke Association. Stroke 35:1023

  10. Adams RJ, Chimowitz MI, Alpert JS, Awad IA, Cerqueria MD, Fayad P, Taubert KA (2003) Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/ American Stroke Association. Stroke 34:2310-322

    Article  PubMed  Google Scholar 

  11. Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, Wright AD, Turner RC, Holman RR (2000) Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 321:412-19

    Article  CAS  PubMed  Google Scholar 

  12. Albers GW, Caplan LR, Easton JD, Fayad PB, Mohr JP, Saver JL, Sherman DG (2002) Transient ischemic attack -proposal for a new definition. N Engl J Med 347:1713-716

    Article  PubMed  Google Scholar 

  13. Albers GW, Easton JD, Sacco RL, Teal P (1998) Antithrombotic and thrombolytic therapy for ischemic stroke. Chest 114:683S-98S

    Article  CAS  PubMed  Google Scholar 

  14. Algra A, van Gijn J (1996) Aspirin at any dose above 30 mg offers only modest protection after cerebral ischaemia. J Neurol Neurosurg Psychiatry 60:197-99

    Article  CAS  PubMed  Google Scholar 

  15. Amarenco P, Bogousslavsky J, Callahan A 3rd, Goldstein LB, Hennerici M, Rudolph AE, Sillesen H, Simunovic L, Szarek M, Welch KM, Zivin JA (2006) High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 355:549-59

    Article  CAS  PubMed  Google Scholar 

  16. Aronow HD, Novaro GM, Lauer MS, Brennan DM, Lincoff AM, Topol EJ, Kereiakes DJ, Nissen SE (2003) Inhospital initiation of lipid-lowering therapy after coronary intervention as a predictor of long-term utilization: a propensity analysis. Arch Intern Med 163:2576-582

    Article  PubMed  Google Scholar 

  17. Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, Rankin RN, Clagett GP, Hachinski VC, Sackett DL, Thorpe KE, Meldrum HE, Spence JD (1998) Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 339:1415-425

    Article  CAS  PubMed  Google Scholar 

  18. Bassetti C, Aldrich MS (1999) Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. Sleep 22:217-23

    CAS  PubMed  Google Scholar 

  19. Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, Cacoub P, Cohen EA, Creager MA, Easton JD, Flather MD, Haffner SM, Hamm CW, Hankey GJ, Johnston SC, Mak KH, Mas JL, Montalescot G, Pearson TA, Steg PG, Steinhubl SR, Weber MA, Brennan DM, Fabry-Ribaudo L, Booth J, Topol EJ (2006) Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 354:1706-717

    Article  CAS  PubMed  Google Scholar 

  20. Bhatt DL, Steg PG, Ohman EM, Hirsch AT, Ikeda Y, Mas JL, Goto S, Liau CS, Richard AJ, Rother J, Wilson PW (2006) International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 295:180-89

    Article  CAS  PubMed  Google Scholar 

  21. Bønaa KH, Njolstad I, Ueland PM, Schirmer H, Tverdal A, Steigen T, Wang H, Nordrehaug JE, Arnesen E, Rasmussen K (2006) Homocysteine lowering and cardiovascular events after acute myocardial infarction. N Engl J Med 354:1578-588

    Article  PubMed  Google Scholar 

  22. Bond R, Rerkasem K, Rothwell PM (2003) Systematic review of the risks of carotid endarterectomy in relation to the clinical indication for and timing of surgery. Stroke 34:2290-301

    Article  CAS  PubMed  Google Scholar 

  23. Bresalier RS, Sandler RS, Quan H, Bolognese JA, Oxenius B, Horgan K, Lines C, Riddell R, Morton D, Lanas A, Konstam MA, Baron JA (2005) Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med 352:1092-102

    Article  CAS  PubMed  Google Scholar 

  24. Bronner LL, Kanter DS, Manson JE (1995) Primary prevention of stroke. N Engl J Med 333:1392-400

    Article  CAS  PubMed  Google Scholar 

  25. CAPRIE Steering Committee (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 348:1329-339

    Article  Google Scholar 

  26. Carlberg B, Asplund K, Hagg E (1991) Factors influencing admission blood pressure levels in patients with acute stroke. Stroke 22:527-30

    CAS  PubMed  Google Scholar 

  27. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ (2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 289:2560-572

    Article  CAS  PubMed  Google Scholar 

  28. Connolly S, Pogue J, Hart R, Pfeffer M, Hohnloser S, Chrolavicius S, Yusuf S (2006) Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet 367:1903-912

    Article  CAS  PubMed  Google Scholar 

  29. Corvol JC, Bouzamondo A, Sirol M, Hulot JS, Sanchez P, Lechat P (2003) Differential effects of lipid-lowering therapies on stroke prevention: a meta-analysis of randomized trials. Arch Intern Med 163:669-76

    Article  CAS  PubMed  Google Scholar 

  30. Coull AJ, Lovett JK, Rothwell PM (2004) Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. BMJ 328:326

    Article  CAS  PubMed  Google Scholar 

  31. D'Agostino RB, Wolf PA, Belanger AJ, Kannel WB (1994) Stroke risk profile: adjustment for antihypertensive medication. The Framingham Study. Stroke 25:40-3

    PubMed  Google Scholar 

  32. Dahlöf B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, de Faire U, Fyhrquist F, Ibsen H, Kristiansson K, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Wedel H (2002) Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 359:995-003

    Article  PubMed  Google Scholar 

  33. De Schryver EL, Algra A, van Gijn J (2006) Dipyridamole for preventing stroke and other vascular events in patients with vascular disease. Cochrane Database Syst Rev:CD001820

    Google Scholar 

  34. Di Mascio R, Marchioli R, Tognoni G (2000) Cholesterol reduction and stroke occurrence: an overview of randomized clinical trials. Cerebrovasc Dis 10:85-2

    Article  CAS  PubMed  Google Scholar 

  35. Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ (2004) Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 364:331-37

    Article  CAS  PubMed  Google Scholar 

  36. Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ (2004) Management of atherothrombosis with clopidogrel in high-risk patients with recent transient ischaemic attack or ischaemic stroke (MATCH): study design and baseline data. Cerebrovasc Dis 17:253-61

    Article  CAS  PubMed  Google Scholar 

  37. Diener HC, Cunha L, Forbes C, Sivenius J, Smets P, Lowenthal A (1996) European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 143:1-3

    Article  CAS  PubMed  Google Scholar 

  38. Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK, Skene AM, Tan MH, Lefebvre PJ, Murray GD, Standl E, Wilcox RG, Wilhelmsen L, Betteridge J, Birkeland K, Golay A, Heine RJ, Koranyi L, Laakso M, Mokan M, Norkus A, Pirags V, Podar T, Scheen A, Scherbaum W, Schernthaner G, Schmitz O, Skrha J, Smith U, Taton J (2005) Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet 366:1279-289

    Article  CAS  PubMed  Google Scholar 

  39. Fonarow GC (2003) The role of inhospital initiation of cardiovascular protective therapies to improve treatment rates and clinical outcomes. Rev Cardiovasc Med 4(Suppl 3):S37–S46

    PubMed  Google Scholar 

  40. Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B (2006) ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur Heart J 27:1979-030

    Article  PubMed  Google Scholar 

  41. Goldstein LB, Adams R, Becker K, Furberg CD, Gorelick PB, Hademenos G, Hill M, Howard G, Howard VJ, Jacobs B, Levine SR, Mosca L, Sacco RL, Sherman DG, Wolf PA, del Zoppo GJ (2001) Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. Circulation 103:163-82

    CAS  PubMed  Google Scholar 

  42. Gorelick PB, Sacco RL, Smith DB, Alberts M, Mustone-Alexander L, Rader D, Ross JL, Raps E, Ozer MN, Brass LM, Malone ME, Goldberg S, Booss J, Hanley DF, Toole JF, Greengold NL, Rhew DC (1999) Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA 281:1112-120

    Article  CAS  PubMed  Google Scholar 

  43. Goyen M, Herborn CU, Kroger K, Lauenstein TC, Debatin JF, Ruehm SG (2003) Detection of atherosclerosis: systemic imaging for systemic disease with whole-body three-dimensional MR angiography -initial experience. Radiology 227:277-82

    Article  PubMed  Google Scholar 

  44. Grundmann K, Jaschonek K, Kleine B, Dichgans J, Topka H (2003) Aspirin non-responder status in patients with recurrent cerebral ischemic attacks. J Neurol 250:63-6

    Article  CAS  PubMed  Google Scholar 

  45. Gueyffier F, Boissel JP, Boutitie F, Pocock S, Coope J, Cutler J, Ekbom T, Fagard R, Friedman L, Kerlikowske K, Perry M, Prineas R, Schron E (1997) Effect of antihypertensive treatment in patients having already suffered from stroke. Gathering the evidence. The INDANA (INdividual Data ANalysis of Antihypertensive intervention trials) Project Collaborators. Stroke 28:2557-562

    CAS  PubMed  Google Scholar 

  46. Halkes PH, van Gijn J, Kappelle LJ, Koudstaal PJ, Algra A (2006) Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet 367:1665-673

    Article  CAS  PubMed  Google Scholar 

  47. Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, Thomas D (2004) Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 363:1491-502

    Article  CAS  PubMed  Google Scholar 

  48. Hankey GJ (2003) Long-term outcome after ischaemic stroke/transient ischaemic attack. Cerebrovasc Dis 16(Suppl 1):14-9

    Article  PubMed  Google Scholar 

  49. Hansson L (2000) Results of the STOPHypertension- 2 trial. Blood Press (Suppl 2):17-0

    Google Scholar 

  50. Hardie K, Hankey GJ, Jamrozik K, Broadhurst RJ, Anderson C (2004) Tenyear risk of first recurrent stroke and disability after first-ever stroke in the Perth Community Stroke Study. Stroke 35:731-35

    Article  PubMed  Google Scholar 

  51. Hardie K, Hankey GJ, Jamrozik K, Broadhurst RJ, Anderson C (2003) Tenyear survival after first-ever stroke in the Perth community stroke study. Stroke 34:1842-846

    Article  PubMed  Google Scholar 

  52. Harker LA, Boissel JP, Pilgrim AJ, Gent M (1999) Comparative safety and tolerability of clopidogrel and aspirin: results from CAPRIE. CAPRIE Steering Committee and Investigators. Clopidogrel versus aspirin in patients at risk of ischaemic events. Drug Saf 21:325-35

    Article  CAS  PubMed  Google Scholar 

  53. He FJ, Nowson CA, MacGregor GA (2006) Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet 367:320-26

    Article  PubMed  Google Scholar 

  54. Herbert JM, Dol F, Bernat A, Falotico R, Lale A, Savi P (1998) The antiaggregating and antithrombotic activity of clopidogrel is potentiated by aspirin in several experimental models in the rabbit. Thromb Haemost 80:512-18

    CAS  PubMed  Google Scholar 

  55. Johnston SC, Gress DR, Browner WS, Sidney S (2000) Short-term prognosis after emergency department diagnosis of TIA. JAMA 284:2901-906

    Article  CAS  PubMed  Google Scholar 

  56. Karapanayiotides T, Piechowski- Jozwiak B, van Melle G, Bogousslavsky J, Devuyst G (2004) Stroke patterns, etiology, and prognosis in patients with diabetes mellitus. Neurology 62:1558-562

    PubMed  Google Scholar 

  57. Kearney PM, Baigent C, Godwin J, Halls H, Emberson JR, Patrono C (2006) Do selective cyclo-oxygenase-2 inhibitors and traditional nonsteroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ 332:1302-308

    Article  CAS  PubMed  Google Scholar 

  58. Keech A, Simes RJ, Barter P, Best J, Scott R, Taskinen MR, Forder P, Pillai A, Davis T, Glasziou P, Drury P, Kesaniemi YA, Sullivan D, Hunt D, Colman P, d'Emden M, Whiting M, Ehnholm C, Laakso M (2005) Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 366:1849-861

    Article  CAS  PubMed  Google Scholar 

  59. Law MR, Wald NJ, Morris JK, Jordan RE (2003) Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ 326:1427

    Article  CAS  PubMed  Google Scholar 

  60. Lindholm LH, Carlberg B, Samuelsson O (2005) Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet 366:1545-553

    Article  CAS  PubMed  Google Scholar 

  61. Lonn E, Yusuf S, Arnold MJ, Sheridan P, Pogue J, Micks M, McQueen MJ, Probstfield J, Fodor G, Held C, Genest J Jr (2006) Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med 354:1567-577

    Article  CAS  PubMed  Google Scholar 

  62. MacMahon S, Rodgers A (1994) Blood pressure, antihypertensive treatment and stroke risk. J Hypertens Suppl 12:S5–S14

    CAS  PubMed  Google Scholar 

  63. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046-053

    PubMed  Google Scholar 

  64. Markus HS, Droste DW, Kaps M, Larrue V, Lees KR, Siebler M, Ringelstein EB (2005) Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 111:2233-240

    Article  CAS  PubMed  Google Scholar 

  65. Mas JL, Chatellier G, Beyssen B (2004) Carotid angioplasty and stenting with and without cerebral protection: clinical alert from the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S) trial. Stroke 35:e18–e20

    CAS  PubMed  Google Scholar 

  66. Mohr JP, Thompson JL, Lazar RM, Levin B, Sacco RL, Furie KL, Kistler JP, Albers GW, Pettigrew LC, Adams HP Jr, Jackson CM, Pullicino P (2001) A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 345:1444-451

    Article  CAS  PubMed  Google Scholar 

  67. Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, Raskin P, Zinman B (2005) Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 353:2643-653

    Article  PubMed  Google Scholar 

  68. Ness J, Aronow WS (1999) Prevalence of coexistence of coronary artery disease, ischemic stroke, and peripheral arterial disease in older persons, mean age 80 years, in an academic hospitalbased geriatrics practice. J Am Geriatr Soc 47:1255-256

    CAS  PubMed  Google Scholar 

  69. Ostermayer SH, Reisman M, Kramer PH, Matthews RV, Gray WA, Block PC, Omran H, Bartorelli AL, Della Bella P, Di Mario C, Pappone C, Casale PN, Moses JW, Poppas A, Williams DO, Meier B, Skanes A, Teirstein PS, Lesh MD, Nakai T, Bayard Y, Billinger K, Trepels T, Krumsdorf U, Sievert H (2005) Percutaneous left atrial appendage transcatheter occlusion (PLAATO system) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation: results from the international multi-center feasibility trials. J Am Coll Cardiol 46:9-4

    Article  PubMed  Google Scholar 

  70. Ovbiagele B, Saver JL, Fredieu A, Suzuki S, McNair N, Dandekar A, Razinia T, Kidwell CS (2004) PROTECT: a coordinated stroke treatment program to prevent recurrent thromboembolic events. Neurology 63:1217-222

    CAS  PubMed  Google Scholar 

  71. Ovbiagele B, Saver JL, Fredieu A, Suzuki S, Selco S, Rajajee V, McNair N, Razinia T, Kidwell CS (2004) In-hospital initiation of secondary stroke prevention therapies yields high rates of adherence at follow-up. Stroke 35:2879-883

    Article  PubMed  Google Scholar 

  72. Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP, Franklin BA, Goldstein LB, Greenland P, Grundy SM, Hong Y, Miller NH, Lauer RM, Ockene IS, Sacco RL, Sallis JF Jr, Smith SC Jr, Stone NJ, Taubert KA (2002) AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association Science Advisory and Coordinating Committee. Circulation 106:388-91

    Article  PubMed  Google Scholar 

  73. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 329:15-9

    Article  PubMed  Google Scholar 

  74. Rauch U, Osende JI, Fuster V, Badimon JJ, Fayad Z, Chesebro JH (2001) Thrombus formation on atherosclerotic plaques: pathogenesis and clinical consequences. Ann Intern Med 134:224-38

    CAS  PubMed  Google Scholar 

  75. Ridker PM, Cook NR, Lee IM, Gordon D, Gaziano JM, Manson JE, Hennekens CH, Buring JE (2005) A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 352:1293-304

    Article  CAS  PubMed  Google Scholar 

  76. Ringleb PA, Allenberg J, Bruckmann H, Eckstein HH, Fraedrich G, Hartmann M, Hennerici M, Jansen O, Klein G, Kunze A, Marx P, Niederkorn K, Schmiedt W, Solymosi L, Stingele R, Zeumer H, Hacke W (2006) 30 day results from the SPACE trial of stentprotected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 368:1239-247

    Article  CAS  PubMed  Google Scholar 

  77. Ringleb PA, Bhatt DL, Hirsch AT, Topol EJ, Hacke W (2004) Benefit of clopidogrel over aspirin is amplified in patients with a history of ischemic events. Stroke 35:528-32

    Article  CAS  PubMed  Google Scholar 

  78. Rosamond WD, Folsom AR, Chambless LE, Wang CH, McGovern PG, Howard G, Copper LS, Shahar E (1999) Stroke incidence and survival among middleaged adults: 9-year follow-up of the Atherosclerosis Risk in Communities (ARIC) cohort. Stroke 30:736-43

    CAS  PubMed  Google Scholar 

  79. Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ (2004) Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 363:915-24

    Article  CAS  PubMed  Google Scholar 

  80. Rothwell PM, Giles MF, Flossmann E, Lovelock CE, Redgrave JN, Warlow CP, Mehta Z (2005) A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet 366:29-6

    Article  CAS  PubMed  Google Scholar 

  81. Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T (2006) Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke 37:577-17

    Article  PubMed  Google Scholar 

  82. Sacco RL, Shi T, Zamanillo MC, Kargman DE (1994) Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: the Northern Manhattan Stroke Study. Neurology 44:626-34

    CAS  PubMed  Google Scholar 

  83. Schrader J, Luders S, Kulschewski A, Berger J, Zidek W, Treib J, Einhaupl K, Diener HC, Dominiak P (2003) The ACCESS Study: evaluation of Acute Candesartan Cilexetil Therapy in Stroke Survivors. Stroke 34:1699-703

    Article  PubMed  Google Scholar 

  84. Schrader J, Luders S, Kulschewski A, Hammersen F, Plate K, Berger J, Zidek W, Dominiak P, Diener HC (2005) Morbidity and Mortality After Stroke, Eprosartan Compared with Nitrendipine for Secondary Prevention: principal results of a prospective randomized controlled study (MOSES). Stroke 36:1218-226

    Article  CAS  PubMed  Google Scholar 

  85. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, O'Connor GT, Boland LL, Schwartz JE, Samet JM (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19-5

    CAS  PubMed  Google Scholar 

  86. Solomon SD, McMurray JJ, Pfeffer MA, Wittes J, Fowler R, Finn P, Anderson WF, Zauber A, Hawk E, Bertagnolli M (2005) Cardiovascular risk associated with celecoxib in a clinical trial for colorectal adenoma prevention. N Engl J Med 352:1071-080

    Article  CAS  PubMed  Google Scholar 

  87. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhager WH, Bulpitt CJ, de Leeuw PW, Dollery CT, Fletcher AE, Forette F, Leonetti G, Nachev C, O'Brien ET, Rosenfeld J, Rodicio JL, Tuomilehto J, Zanchetti A (1997) Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 350:757-64

    Article  CAS  PubMed  Google Scholar 

  88. Steinhubl SR, Berger PB, Mann JT 3rd, Fry ET, DeLago A, Wilmer C, Topol EJ (2002) Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 288:2411-420

    Article  CAS  PubMed  Google Scholar 

  89. Straus SE, Majumdar SR, McAlister FA (2002) New evidence for stroke prevention: scientific review. JAMA 288:1388-395

    Article  PubMed  Google Scholar 

  90. Teo K, Yusuf S, Sleight P, Anderson C, Mookadam F, Ramos B, Hilbrich L, Pogue J, Schumacher H (2004) Rationale, design, and baseline characteristics of 2 large, simple, randomized trials evaluating telmisartan, ramipril, and their combination in high-risk patients: the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial/Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease (ONTARGET/TRANSCEND) trials. Am Heart J 148:52-1

    Article  PubMed  CAS  Google Scholar 

  91. Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J, Manolio T, Zheng ZJ, Flegal K, O'Donnell C, Kittner S, Lloyd-Jones D, Goff DC Jr, Hong Y, Adams R, Friday G, Furie K, Gorelick P, Kissela B, Marler J, Meigs J, Roger V, Sidney S, Sorlie P, Steinberger J, Wasserthiel-Smoller S, Wilson M, Wolf P (2006) Heart disease and stroke statistics -2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 113:e85–e151

    Article  PubMed  Google Scholar 

  92. Turnbull F (2003) Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 362:1527-535

    Article  CAS  PubMed  Google Scholar 

  93. Ussia GP, Mangiafico S, Privitera A, Mule M, Caruso E, Galassi AR, Famoso G, Tamburino C (2006) Percutaneous left atrial appendage transcatheter occlusion in patients with chronic nonvalvular atrial fibrillation: early institutional experience. J Cardiovasc Med (Hagerstown) 7:569-72

    Article  Google Scholar 

  94. Weisman SM, Graham DY (2002) Evaluation of the benefits and risks of low-dose aspirin in the secondary prevention of cardiovascular and cerebrovascular events. Arch Intern Med 162:2197-202

    Article  CAS  PubMed  Google Scholar 

  95. Wolf PA, Clagett GP, Easton JD, Goldstein LB, Gorelick PB, Kelly-Hayes M, Sacco RL, Whisnant JP (1999) Preventing ischemic stroke in patients with prior stroke and transient ischemic attack: a statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke 30:1991-994

    CAS  PubMed  Google Scholar 

  96. Wolf PA, D’Agostino RB, Belanger AJ, Kannel WB (1991) Probability of stroke: a risk profile from the Framingham Study. Stroke 22:312-18

    CAS  PubMed  Google Scholar 

  97. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K (2004) Protected carotidartery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493-501

    Article  CAS  PubMed  Google Scholar 

  98. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353:2034-041

    Article  CAS  PubMed  Google Scholar 

  99. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK (2001) Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 345:494-02

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Dept. of Neurology, Northwestern University, Feinberg School of Medicine, 710 North Lake Shore Drive, Room 1420, Chicago, IL, 60611, USA

    M. J. Alberts M.D.

  2. UCLA Stroke Center, Los Angeles, California

    B. Ovbiagele M.D.

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  1. M. J. Alberts M.D.
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Correspondence to M. J. Alberts M.D..

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Financial Disclosure: Dr.Alberts is a consultant and has received honoraria, speaker fees, and research funding from Sanofi-Aventis, Bristol-Myers Squibb, Boehringer-Ingelheim, Pfizer, Bayer, and AstraZeneca. Dr. Ovbiagele is a consultant and has received honoraria and research funding from Sanofi-Aventis and Bristol-Myers Squibb, and from Boehringer-Ingelheim.

Acknowledgement: The authors would like to thank Susan Abulhawa for editorial support in the preparation of the manuscript. This assistance was funded by Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership.

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Alberts, M.J., Ovbiagele, B. Current strategies for ischemic stroke prevention: role of multimodal combination therapies. J Neurol 254, 1414–1426 (2007). https://doi.org/10.1007/s00415-007-0569-9

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  • DOI: https://doi.org/10.1007/s00415-007-0569-9

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